Second-line chemotherapy for advanced or recurrent endometrial carcinoma previously treated with paclitaxel and carboplatin, with or without epirubicin

Yutaka Ueda, Takahito Miyake, Tomomi Egawa-Takata, Takashi Miyatake, Shinya Matsuzaki, Takuhei Yokoyama, Kiyoshi Yoshino, Masami Fujita, Takayuki Enomoto, Tadashi Kimura, Yutaka Ueda, Takahito Miyake, Tomomi Egawa-Takata, Takashi Miyatake, Shinya Matsuzaki, Takuhei Yokoyama, Kiyoshi Yoshino, Masami Fujita, Takayuki Enomoto, Tadashi Kimura

Abstract

Purpose: A combined chemotherapy of taxane and platinum, with or without anthracycline, has been used as a standard first-line regimen. The purpose of this study was to investigate the effectiveness of second-line chemotherapy for treatment of advanced or recurrent endometrial carcinoma previously treated with a combined chemotherapy of taxane and platinum, with or without anthracycline.

Methods: During the 2000-2008 study period, 723 patients were diagnosed with endometrial cancer at the Departments of Obstetrics and Gynecology of the Osaka University and the Osaka Rosai Hospitals, Osaka, Japan. The subset of these cases that eventually required treatment by second-line chemotherapy was retrospectively analyzed.

Results: Response rate to second-line chemotherapy was 25%. Treatment-free interval (TFI) of ≥ or <6 months was demonstrated to be significantly associated with the response to second-line chemotherapy (P = 0.0026), progression-free survival (P = 0.0003) and overall survival (P = 0.025). The second-line chemotherapy similar to the first-line regimen was ineffective in all the 7 cases (100%) whose TFI was shorter than 6 months. Multivariate analysis showed that TFI was the most significantly important factor predicting the effectiveness of second-line chemotherapy (the adjusted hazard ratio of TFI on PFS and OS: 3.482, 95% CI, 1.641-7.388, P = 0.0012, and 2.341, 95% CI, 1.034-5.301, P = 0.042, respectively).

Conclusions: Our present study provides, for the first time, evidence that the majority of refractory or recurrent diseases, if they occur within 6 months of a first-line chemotherapy using taxane and platinum with or without anthracycline, are non-responsive to the current regimens of second-line chemotherapy.

Figures

Fig. 1
Fig. 1
PFS and OS after second-line chemotherapy by TFI. Progression-free probability and overall probability after second-line chemotherapy of the patients whose TFI was equal to or longer than 6 months were significantly longer than those whose TFI was shorter than 6 months (P = 0.0003 and P = 0.025, respectively, by the log-rank test)

References

    1. DiSaia PJ, Creasman WT. Clinical gynecologic oncology. 6. Mosby: St. Louis; 2002.
    1. Bristow RE, Zerbe MJ, Rosenshein NB, Grumbine FC, Montz FJ. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol. 2000;78:85–91. doi: 10.1006/gyno.2000.5843.
    1. Berek JS. Novak’s Gynecology. 13. Baltimore: William and Wilkins; 2002.
    1. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA. Gynecologic oncology group study randomized phase iii trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol. 2006;24:36–44. doi: 10.1200/JCO.2004.00.7617.
    1. Susumu N, Sagae S, Udagawa Y, Niwa K, Kuramoto H, Satoh S, Kudo R. Japanese gynecologic oncology group randomized phase iii trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate—and high risk endometrial cancer: a Japanese gynecologic oncology group study. Gynecol Oncol. 2008;108:226–233. doi: 10.1016/j.ygyno.2007.09.029.
    1. Aapro MS, van Wijk FH, Bolis G, Chevallier B, van der Burg ME, Poveda A, de Oliveira CF, Tumolo S, Scotto di Palumbo V, Piccart M, Franchi M, Zanaboni F, Lacave AJ, Fontanelli R, Favalli G, Zola P, Guastalla JP, Rosso R, Marth C, Nooij M, Presti M, Scarabelli C, Splinter TA, Ploch E, Beex LV, Ten Bokkel Huinink W, Forni M, Melpignano M, Blake P, Kerbrat P, Mendiola C, Cervantes A, Goupil A, Harper PG, Madronal C, Namer M, Scarfone G, Stoot JE, Teodorovic I, Coens C, Vergote I, Vermorken JB. European organisation for research, treatment of cancer gynaecological cancer group. Doxorubicin versus doxorubicin, cisplatin in endometrial carcinoma: definitive results of a randomised study (55872) by the EORTC gynaecological cancer group. Ann Oncol. 2003;14:441–448. doi: 10.1093/annonc/mdg112.
    1. Ball HG, Blessing JA, Lentz SS, Mutch DG. A phase II trial of paclitaxel in patients with advanced or recurrent adenocarcinoma of the endometrium: a gynecologic oncology group study. Gynecol Oncol. 1996;62:278–281. doi: 10.1006/gyno.1996.0227.
    1. Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, Munkarah AR, Kline R, Burger RA, Goodman A, Burks RT. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22:2159–2166. doi: 10.1200/JCO.2004.07.184.
    1. Lissoni A, Gabriele A, Gorga G, Tumolo S, Landoni F, Mangioni C, Sessa C. Cisplatin-, epirubicin- and paclitaxel-containing chemotherapy in uterine adenocarcinoma. Ann Oncol. 1997;8:969–972. doi: 10.1023/A:1008221310453.
    1. Sovak MA, Hensley ML, Dupont J, Ishill N, Alektiar KM, Abu-Rustum N, Barakat R, Chi DS, Sabbatini P, Spriggs DR, Aghajanian C. Paclitaxel and carboplatin in the adjuvant treatment of patients with high-risk stage III and IV endometrial cancer: a retrospective study. Gynecol Oncol. 2006;103:451–457. doi: 10.1016/j.ygyno.2006.03.019.
    1. Papadimitriou CA, Bafaloukos D, Bozas G, Kalofonos H, Kosmidis P, Aravantinos G, Fountzilas G, Dimopoulos MA. Hellenic co-operative oncology group. Paclitaxel, epirubicin, and carboplatin in advanced or recurrent endometrial carcinoma: a Hellenic co-operative oncology group (HeCOG) study. Gynecol Oncol. 2008;110:87–92. doi: 10.1016/j.ygyno.2008.03.004.
    1. Hoskins PJ, Swenerton KD, Pike JA, Wong F, Lim P, Acquino-Parsons C, Lee N. Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study. J Clin Oncol. 2001;19:4048–4053.
    1. du Bois A, Neijt JP, Thigpen JT. First-line chemotherapy with carboplatin plus paclitaxel in advanced ovarian cancer–a new standard of care? Ann Oncol. 1999;10(Suppl 1):35–41. doi: 10.1023/A:1008355317514.
    1. Havrilesky LJ, Alvarez AA, Sayer RA, Lancaster JM, Soper JT, Berchuck A, Clarke-Pearson DL, Rodriguez GC, Carney ME. Weekly low-dose carboplatin and paclitaxel in the treatment of recurrent ovarian and peritoneal cancer. Gynecol Oncol. 2003;88:51–57. doi: 10.1006/gyno.2002.6859.
    1. Kikuchi A, Sakamoto H, Yamamoto T. Weekly carboplatin and paclitaxel is safe, active, and well tolerated in recurrent ovarian cancer cases of Japanese women previously treated with cisplatin-containing multidrug chemotherapy. Int J Gynecol Cancer. 2005;15:45–49. doi: 10.1111/j.1048-891X.2005.15006.x.
    1. World Health Organization . WHO handbook of reporting results of cancer treatment no. 48. Geneva: WHO Offset Publication; 1979.
    1. Pectasides D, Xiros N, Papaxoinis G, Pectasides E, Sykiotis C, Koumarianou A, Psyrri A, Gaglia A, Kassanos D, Gouveris P, Panayiotidis J, Fountzilas G, Economopoulos T. Carboplatin and paclitaxel in advanced or metastatic endometrial cancer. Gynecol Oncol. 2008;109:250–254. doi: 10.1016/j.ygyno.2008.01.028.
    1. Bartsch R, Wenzel C, Altorjai G, Pluschnig U, Rudas M, Mader RM, Gnant M, Zielinski CC, Steger GG. Capecitabine and trastuzumab in heavily pretreated metastatic breast cancer. J Clin Oncol. 2007;25:3853–3858. doi: 10.1200/JCO.2007.11.9776.
    1. Ueno Y, Enomoto T, Otsuki Y, Sugita N, Nakashima R, Yoshino K, Kuragaki C, Ueda Y, Aki T, Ikegami H, Yamazaki M, Ito K, Nagamatsu M, Nishizaki T, Asada M, Kameda T, Wakimoto A, Mizutani T, Yamada T, Murata Y. Prognostic significance of p53 mutation in sub optimally resected advanced ovarian carcinoma treated with the combination chemotherapy of paclitaxel and carboplatin. Cancer Lett. 2006;241:289–300. doi: 10.1016/j.canlet.2005.10.035.
    1. Markman M, Markman J, Webster K, Zanotti K, Kulp B, Peterson G, Belinson J. Duration of response to second-line, platinum-based chemotherapy for ovarian cancer: implications for patient management and clinical trial design. J Clin Oncol. 2004;22:3120–3125. doi: 10.1200/JCO.2004.05.195.
    1. Harries M, Gore M. Part II: chemotherapy for epithelial ovarian cancer-treatment of recurrent disease. Lancet Oncol. 2002;3:537–545. doi: 10.1016/S1470-2045(02)00847-1.
    1. Blackledge G, Lawton F, Redman C, Kelly K. Response of patients in phase II studies of chemotherapy in ovarian cancer: implications for patient treatment and the design of phase II trials. Br J Cancer. 1989;59:650–653. doi: 10.1038/bjc.1989.132.
    1. Gore ME, Fryatt I, Wiltshaw E, Dawson T. Treatment of relapsed carcinoma of the ovary with cisplatin or carboplatin following initial treatment with these compounds. Gynecol Oncol. 1990;36:207–211. doi: 10.1016/0090-8258(90)90174-J.
    1. Markman M, Reichman B, Hakes T, Jones W, Lewis JL, Jr, Rubin S, Almadrones L, Hoskins W. Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol. 1991;9:1801–1805.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi